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General NPI Number Information
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NPI Number | 1700165297
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Entity Type | Organization
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Legal Business Name | BUTTERFLY EFFECTS
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Dates
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Enumeration Date | 08/15/2011
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Last Update Date | 08/15/2011
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Provider Practice Location Address
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Address Line | 7162 E 26TH ST
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City | YUMA
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State | AZ
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Zip | 85365-7876
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Country | US
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Telephone | 815-508-5303
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Fax |
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Provider Business Mailing Address
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Address Line | 7162 E 26TH ST
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City | YUMA
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State | AZ
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Zip | 85365-7876
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Country | US
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Telephone | 815-508-5303
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Fax |
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Authorized Official
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Title or Position | TUTOR
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Name | JENNA SCOTT
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Credential |
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Telephone | 815-508-5303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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